{include file="public/header"}
<body>
    <style>
        .layui-form-label{
            width: 200px;
        }
        .layui-input{
            width:70%;
        }
    </style>

        <form class="layui-form" action="">
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 上级代理商名称</label>
                <div class="layui-input-block">
                    <input type="text" value="{$uper_name}" readonly class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 代理商名称</label>
                <div class="layui-input-block">
                    <input type="text" name="name" required value="" lay-verify="required" placeholder="代理商名" class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 手机号</label>
                <div class="layui-input-block">
                    <input type="text" name="mobile" required value="" lay-verify="phone" placeholder="必须是11位手机号码" class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 银行卡号</label>
                <div class="layui-input-block">
                    <input type="text" name="card_number" required value="" lay-verify="required" placeholder="请输入银行卡号" class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 对应银行名称</label>
                <div class="layui-input-block">
                    <input type="text" name="card_bank" required value="" lay-verify="required" placeholder="请输入卡号对应的银行名称" class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 持卡人姓名</label>
                <div class="layui-input-block">
                    <input type="text" name="card_name" required value="" lay-verify="required" placeholder="请输入持卡人姓名" class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 身份证号</label>
                <div class="layui-input-block">
                    <input type="text" name="id_card" required value="" lay-verify="required" placeholder="请输入身份证号" class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 绑定手机</label>
                <div class="layui-input-block">
                    <input type="text" name="card_mobile" required value="" lay-verify="phone" placeholder="银行卡绑定的手机号" class="layui-input">
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 等级选择</label>
                <div class="layui-input-block">
                    <select name="level">
                        <option value=""></option>
                        <option value="0">县级代理</option>
                        <option value="1">市级代理</option>
                        <option value="2">省级代理</option>
                    </select>
                </div>
            </div>
            <div class="layui-form-item">
                <label class="layui-form-label"><span style="color:red">*</span> 代理商地址</label>
                <div class="layui-input-block">
                    <input type="text" name="address" required value="" lay-verify="required" placeholder="请输入代理商地址" class="layui-input">
                </div>
            </div>

            <div class="layui-form-item">
                <div class="layui-input-block">
                    <button class="layui-btn" lay-submit lay-filter="admin-form">立即提交</button>
                    <button type="reset" class="layui-btn layui-btn-primary">重置</button>
                </div>
            </div>
        </form>


{include file="public/footer"}

    <script>
        layui.use('form', function(){
            var form = layui.form();
            form.on('submit(admin-form)', function(data){
                var params  = {
                    url: '{:url("add")}',
                    data: data.field,
                    type: 'post',
                    sCallback:function(res){
                        layer.msg(res.msg,{time:1800},function(){
                            location.reload();
                        });
                    }
                };
                common.request(params);
                return false;
            });

        });
    </script>

</body>
</html>